The app is spreading. Now numbering in the hundreds of thousands, applications for smartphones and tablets reach into nearly every aspect of daily life, and the practice of dermatology is no exception. Mobile devices, powered by apps customized for dermatology, are helping practitioners to streamline record-keeping and billing, expand their clinical capabilities, keep current with the latest news and research developments, and enhance their interaction with patients.

Mobile technology “has definitely improved practice,” said Daniel M. Siegel, MD, clinical professor of dermatology at SUNY Downstate College of Medicine and president-elect of the American Academy of Dermatology. “If you’ve got technology in the exam room, and an issue comes up, the easiest thing is to say to the patient, Let’s find out.’ Certain websites have become major resources, a quick way to find answers about diseases that you might not be very familiar with at the moment.”

Sifting through the plethora of medical and dermatology-related apps can be time-consuming. The search term “dermatology” in Apple’s iTunes app store found 81 apps for the iPhone and 34 for the iPad, as well as 50 podcasts. The BlackBerry App World has 13 dermatology-specific apps, and the Android Market has 67. The number of broader medical apps, some of which have dermatology subsections, is far greater. Following are some of the favorites selected by a group of tech-savvy dermatologists.[pagebreak]

Dermatology apps

Dr. Siegel cited two dermoscopy apps that can serve as training aids to dermatologists who are new to dermoscopy. Dermoscopy Tutorial, a basic introduction to dermoscopy, features hundreds of images and is targeted to healthcare workers who diagnose melanomas and other skin tumors. Dermoscopy, developed by dermoscopy and pigmented lesion expert Babar K. Rao, M.D., aims to educate dermatologists in the use of dermoscopy. Dr. Rao’s app “takes a simple approach to pigmented lesions, which lets you look at lesions, look at the findings, and then determine if what you’re looking at looks like those findings,” Dr. Siegel said. “Then it can help you make a decision as to whether or not to biopsy. I think these are both really neat for beginners.”

VisualDx Mobile, a companion to the VisualDX Clinician decision-support system, combines physician-reviewed clinical information with thousands of medical images of skin lesions, growths, and rashes. In addition to determining a diagnosis, physicians can search by disease for next steps on management, review ICD-9 codes, and search by drug for medication-induced diseases. “Most dermatologists won’t need VisualDX frequently, but it can be helpful in a tough circumstance,” said Dr. Siegel, who has a consulting relationship with developer Logical Images, Inc. “It may be more helpful for the non-derm, but from the derm point of view, if you have something uncommon or unusual, not only can it help you hone in on a diagnosis once you’ve gotten there, it also has a therapeutics textbook.”

A mobile version of Litt’s D.E.R.M. Database, a key resource for dermatologists since its debut in print 20 years ago, allows subscribers to search the profiles of thousands of generic and trade name drugs and includes information regarding drug eruptions, interactions, and adverse reactions. “I’ve included virtually all the generic drugs approved by the FDA, as well as many others approved by the British and Canadian regulatory agencies,” said Jerome Litt, MD, assistant professor of dermatology at Case Western Reserve University School of Medicine. (Though the site is owned by Informa Healthcare, Dr. Litt receives royalties from subscriptions.) “I update the information every day using journal references on PubMed as well as case reports and anecdotes. The mobile version was introduced about a year ago, after many dermatologists kept asking me when the information would be accessible on their hand-held devices.”[pagebreak]

A mobile app of the Skin Therapy Letter provides instant access to all articles published to date, Dr. Siegel noted. “Within the AAD, we’re looking forward to having an app for the blue journal [Journal of the American Academy of Dermatology], which I think is a major move forward,” he added. In a recent article for the AAD publication Young Physician Focus (“Technically Speaking: Young Physicians are Upwardly Mobile”), Gilly Munavalli, MD, assistant professor of dermatology at the Johns Hopkins University School of Medicine, noted that tablets have an important role in patient education. Dr. Munavalli said he uses an iPad app for HD Sys Integumentary to show cartoons of the skin structure to patients. Peter Lio, MD, assistant professor of clinical dermatology and pediatrics at Northwestern University Feinberg School of Medicine, said he uses dermnetnz.org, the website of the New Zealand Dermatological Society, in a similar way. “It’s brilliant and has amazing pictures and information for patients, far beyond the usual disease brochure,” he said. “I pull it up on my iPad and show it to patients right there in the room for teaching, then give them a printout to take home.”

Another app, Skin Advocate, can help dermatologists connect their patients with advocacy groups that can offer support in dealing with their condition. “I think dermatologists are always looking for ways to help their patients navigate through the tremendous amount of medical information currently available,” said Terry Cronin, MD “The new Skin Advocate app allows professionals to have info at their fingertips that is especially targeted for their patients’ particular diagnosis.” The app, developed by Shadi Kourosh, MD, in conjunction with the Society for Investigative Dermatology, allows doctors to send patients information about an advocacy group via email.[pagebreak]

General medical and reference apps

Epocrates, cited as a favorite by several dermatologists, is a drug reference resource available in four versions, ranging in price from free to $199 per year. The free version offers clinical information on thousands of prescription medicines and hundreds of OTC drug products, a “pill ID” feature that allows the user to enter the pill’s physical characteristics and imprint code, a drug interaction checker, and medical news and information. Paid versions add disease images, information on lab tests, CPT and ICD-9 codes, and a medical dictionary.

Key features of Medscape by WebMD, another top choice, include a disease and condition reference and treatment guide, a tables and protocols reference, continuing medical education activities, and physician, pharmacy, and hospital directories. For access to scientific journals, PubMed on Tap offers full PubMed capability on a hand-held device for $1.99. The BlackBag app from Johnson & Johnson features customizable (by therapeutic area) news feeds, journal summaries, conference coverage, videos, and podcasts.

“If you’re going to spend some money to buy a textbook, the Oxford Handbook of Clinical Medicine app is a really nice book,” Dr. Siegel said. “For those of us not doing general medicine on a daily basis, having a textbook in your pocket is really wonderful. First Consult [available to subscribers of MD Consult] is an easy way to get into your Elsevier textbooks, and the National Comprehensive Cancer Network has a guideline app that includes guidelines for melanoma and non-melanoma skin cancer, head and neck cancer, things we all treat.”[pagebreak]

Utilities

Less glamorous but equally useful are the workhorse utilities like Evernote, iTunes, GoodReader (allows mark-up of PDF files), JotNot Pro (makes your smartphone a scanner), and Dropbox (stores files in the cloud). “Evernote acts like your peripheral brain,” Dr. Lio said. “You can store ideas, disease and treatment pearls, and to-do lists. You can even upload PDFs of actual papers to keep everything in your digital life in one place.” Dr. Munavalli uses iTunes to download podcasts of the AAD’s Dialogues in Dermatology and listen while commuting or at lunch. “I also use iTunes to transfer PDFs of handouts, book chapters, and PDF-converted PowerPoint lectures to reference on my iPad2, using either iBooks or other apps like ReaddleDocs or PDF Reader Pro,” he said.

Early adopters teach colleagues

The use of mobile apps among dermatologists is “viral, spreading like wildfire,” Dr. Siegel said. “The uptake is quicker in the younger population, but it’s very rapid in the older population once they have made the leap to a smartphone. If I turn to one of my 70-year-old friends who is still active and practicing, and show him a neat app, his response is likely to be to go to the app store and download it.” (See sidebar for data on smartphone ownership among dermatologists.)

As more dermatologists adopt mobile devices, their use of mobile apps will likely continue to evolve in innovative ways. For Dr. Lio, the time-honored use of mobile devices for entertainment has a serious role in the care of young patients. “My smartphone gets put to work at least twice a day,” he noted. “If we’re doing a biopsy on a little kid, or if we’re going to use cryotherapy on a lesion, we can give them a game to play or video to watch, and it’s incredible kids are really hypnotizable in this way. We have a no-hold policy for warts and molluscum, and this is a way that kids can sit through it. Even some adults who are anxious around needles appreciate this form of distraction.”

App aims to facilitate consumer skin self-exams

An app named Skin Of Mine, dubbed an “online dermatology solution” in the product description, claims to give consumers a way to monitor moles between physician visits. The user snaps an iPhone picture of the mole, uploads it to a website, and uses a set of online tools to quantify the mole’s symmetry, border regularity, and color regularity. Based on those values, the user can search a database to find moles with similar characteristics. The photos are stored in an online account, and the app can track changes in a mole over time by aligning two photos taken at different times. The user also has the option of uploading the photo, answering a questionnaire, and selecting a dermatologist or nurse practitioner from among those who have agreed to act as consultants in participating states (this option is currently available in six states). After reviewing the case, the expert is supposed to respond with a diagnosis, prescription and/or a recommendation for over-the-counter remedies, therapeutic advice, and links to helpful information. The cost of the consultation ranges from $40 to $65, according to a New York Times story about image-recognition software (“What Is That? Let Your Smartphone Have a Look,” Aug. 31, 2011) though the most recent comment on iTunes suggests that actually connecting with a consultant can be difficult. “I entered information with high hopes,” the commenter wrote while rating the app with one star. “No consultant and no info provided.” Delivering more information online may be part of health care’s future, but patients still want to connect with their doctors.

Recommended apps for mobile devices

The dermatologists interviewed for this article recommended a variety of apps for use by their colleagues, including those listed below.

Dermatology

Dermnetnz.org

Dermoscopy (by Rao Dermatology)

Dermoscopy Tutorial

EMA from Modernizing Medicine

HD Sys Integumentary

Litt’s D.E.R.M. Database

NexTech Practice 2011

Skin Advocate

Skin Therapy Letter

VisualDX

General Medical Reference

3D4 Medical

BlackBag Medical Resources

CPT&M Quick Reference

Epocrates

First Consult by Elsevier

Johns Hopkins ABX Guide: Diagnosis & Treatment of Infectious Diseases

Medical Eponyms

Medscape

Meetings MD

Merck Medicus

Micromedex Drug Information

mobilePDR

National Comprehensive Cancer Network guidelines

Oxford Handbook of Clinical Medicine

Pocket Traditional Chinese Medicine

PubMed on Tap

STAT E&M Coder

STAT ICD-9 Coder

Utilities

Dragon Medical Mobile Recorder

Dropbox

Evernote

Good Reader

iTunes

JotNot Pro

Keeper

Things

Smartphone ownership among dermatologists

A survey of members conducted by the AAD in 2010 asked about smartphone ownership.

An app named Skin Of Mine, dubbed an “online dermatology solution” in the product description, claims to give consumers a way to monitor moles between physician visits. The user snaps an iPhone picture of the mole, uploads it to a website, and uses a set of online tools to quantify the mole’s symmetry, border regularity, and color regularity. Based on those values, the user can search a database to find moles with similar characteristics. The photos are stored in an online account, and the app can track changes in a mole over time by aligning two photos taken at different times. The user also has the option of uploading the photo, answering a questionnaire, and selecting a dermatologist or nurse practitioner from among those who have agreed to act as consultants in participating states (this option is currently available in six states). After reviewing the case, the expert is supposed to respond with a diagnosis, prescription and/or a recommendation for over-the-counter remedies, therapeutic advice, and links to helpful information. The cost of the consultation ranges from $40 to $65, according to a New York Times story about image-recognition software (“What Is That? Let Your Smartphone Have a Look,” Aug. 31, 2011) though the most recent comment on iTunes suggests that actually connecting with a consultant can be difficult. “I entered information with high hopes,” the commenter wrote while rating the app with one star. “No consultant and no info provided.” Delivering more information online may be part of health care’s future, but patients still want to connect with their doctors.